Early diagnosis and follow-up of chronic active Epstein–Barr-virus-associated cardiovascular complications with cardiovascular magnetic resonance imaging

Abstract

Introduction:Chronic active Epstein–Barr virus (EBV) infection (CAEBV) is characterized as chronic or recurrent mononucleosis-like symptoms and elevated EBV deoxyribonucleic acid (EBV-DNA) copies. Cardiovascular complications have high morbidity and mortality. The treatment regimen for CAEBV has not been established yet, resulting in poor prognoses. Herein, we present a case of cardiovascular magnetic resonance imaging (CMRI) evaluation with a series of sequences for CAEBV-associated cardiovascular involvement, which has never been reported.Case presentation:A 16-year-old female (body weight, 55 kg) developed a persistent fever and a positive EBV-DNA level of 28,000 copies/mL. Computed tomography angiography (CTA) showed aneurysms involving the aorta and its major branches, as well as multiple aneurysms and stenoses of the coronary arteries. CMRI of the coronary arteries depicted the dilution and stenosis of the arterial lumen as well as the thickening of the arterial wall. Late gadolinium enhancement (LGE) showed subendocardial and transmural delayed enhancement of the left ventricle, suggesting myocardial infarction.CAEBV and associated cardiovascular complications were diagnosed. After treatment with Medrol and Leflunomide, the clinical manifestation and serological parameters reversed to normal. However, the EBV-DNA level increased again to 13,900 copies/mL 2 months later. A follow-up with aorta CTA showed that the arterial walls of the bilateral common iliac artery aneurysms were thicker with new-onset mural thrombi. The aorta CTA also showed new-onset occlusion of the right coronary artery, but a follow-up of CMRI at the same day did not find new-onset delayed enhancement lesion.Conclusion:This case reminds clinicians of the vital importance of early diagnosis and close follow-up of CAEBV-associated cardiovascular complications. With cine imaging, coronary artery imaging, LGE imaging, and other novel techniques, CMRI can effectively and comprehensively reveal the early and dynamic changes, and act as an important tool in the field of cardiovascular diseases.

Epstein–Barr virus-related hemophagocytic lymphohistiocytosis complicated with coronary artery dilation and acute renal injury in a boy with a novel X-linked inhibitor of apoptosis protein (XIAP) variant: a case report

“…After 10 months, the PE did not reoccur and there were no obvious changes in the CAAs. However, CAEBV with cardiovascular complications has been reported in a relatively large number of patients, with the coronary artery disease being the most common complication [ 18 – 20 ].…”

Chronic Active Epstein-Barr Virus Infection in a Patient with Enteritis, Myositis, and Pericardial Effusion: A Case Report

“…Although the cause of pericardial effusion was not explained by pericardiocentesis, possible causes were ruled out with a negative result of interferon- ing amyloidosis. It was reported that cardiovascular magnetic resonance imaging could effectively and comprehensively reveal the early and dynamic changes presenting as aneurysms and stenoses of the coronary arteries, and act as an important tool in the field of cardiovascular complications (10). Unfortunately, the patient was reluctant to perform this noninvasive approach due to economic reasons and decided to give up treatment in the end.…”

Cardiovascular involvement in Epstein–Barr virus infection

“…There were 10 (18.5%) adults ( 6 , 12 – 20 ) and 44 (71.5%) children (under 18 years old) ( 7 – 9 , 21 – 35 ), ranging in age from 1 year and 5 months to 67 years. In terms of sex, there were 28 male ( 7 , 12 , 16 , 18 , 20 , 23 , 25 , 27 , 28 , 30 – 34 ) and 26 female patients ( 6 , 8 , 9 , 13 , 15 , 17 , 19 , 21 , 22 , 24 , 26 – 29 , 31 , 35 ). Regarding the diagnosis of EBV infection, 23 (42.6%) were diagnosed with AEBV ( 6 , 13 – 15 , 17 , 18 , 25 , 27 , 32 ), 20 (37.0%) with CAEBV ( 7 , 8 , 16 , 19 – 22 , 28 – 31 , 34 ), 6 (11.1%) had a complication of CAEBV and HLH ( 12 , 24 , 28 , 31 ), 4 (7.4%) had a diagnosis of EBV-HLH ( 9 , 23 , 33 , 35 ), and 1 (1.9%) had reactivated EBV ( 26 ).…”

“…Of the included patients, 42 (95.5%) were children ( 7 – 9 , 21 – 31 , 34 , 35 ) and two (4.5%) were adults ( 12 , 16 ). Regarding gender, 23 (52.3%) were male ( 7 , 8 , 23 , 25 , 27 , 28 , 30 , 31 , 34 ) and 21 (47.7%) were female ( 9 , 12 , 16 , 21 , 22 , 24 , 26 – 29 , 31 , 35 ). Pediatric patients ranged in age from 1 year and 5 months to 16 years.…”

“…Pediatric patients ranged in age from 1 year and 5 months to 16 years. Regarding the diagnosis, 16 (36.4%) were diagnosed with AEBV ( 25 , 27 ), one (2.3%) with reactivated EBV but not CAEBV ( 26 ), 18 (40.9%) with CAEBV ( 7 , 8 , 16 , 21 , 22 , 28 – 31 , 34 ), six (13.6%) with CAEBV and HLH ( 12 , 24 , 28 , 31 ), and three (6.8%) with EBV-HLH ( 9 , 23 , 35 ).…”